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Hayley: Hello everyone. My name is Hayley and I am your host for Straight Talk With The Doc; a podcast where I dive into topics on addiction, mental health, and treatment, with addiction medicine specialist Dr. Bhatt. How are you doing Dr. Bhatt?

Dr. Bhatt: Good, Hayley, how are you?

Hayley: I’m doing great, thank you. I’m excited to get into today’s topic because it’s something that so many of us can relate to whether we were directly affected or knew someone whose been affected. In 2019, there were over 19 million people enrolled in colleges across the country. There’s a huge range in the age of students, but the majority of college students are in their early 20’s. The start of college is a huge shift in responsibility and freedom as many people are living on their own for the first time and making their own decisions. This is a time for self-discovery and experimenting, and it’s no secret that this is when a lot of young people start experimenting with drugs and alcohol. So, in today’s episode were going to get into college substance abuse. Should it be considered a normal part of life, and if so, when does it become a problem? Dr. Bhatt, research shows that most young adults start using alcohol and smoking cigarettes at age 17, and first try drugs like Cocaine at 19. Why do people start experimenting with drugs at that age or even younger?

Dr. Bhatt: I think what we’ve seen in the last many years, and there’s a lot of studies done annually—the National Institute on Drug Abuse does a lot of very robust studies on people above the age of 12—is a trend, actually a positive trend, in the onset or the first use of drugs or alcohol starting to be delayed. Now, why do people use in the first place? As we are young, we start to experiment in many things in life. And especially if you’re leaving home for the first time as you mentioned in the beginning- that’s a time of freedom, there’s a time of being influenced from our other peers. Young people start with risk taking behaviors and often it is experimentation to start with drugs or alcohol. The irony is these experimentations turn into chronic usage where we can see a plethora of problems that will ultimately arise. Young adulthood, teenage adolescent years, even beforehand, it’s a time for us to experiment with many, many things in life and unfortunately drugs and alcohol are part of it.

Hayley: Yeah, like you said, a lot of young people do that. Because of that, should substance abuse in college ever be considered normal? Is that okay?

Dr. Bhatt: I think the word normal can be misleading versus it’s prevalent and it’s there and it’s often common. So, I don’t believe normal should be interpreted as okay. So, just because something’s present and happening often doesn’t mean that it’s okay to do. Because unfortunately with chronic usage or even incidental usage, if it causes you to lose control- and we all know substance use can hijack the way we behave and make us act in ways that we normally wouldn’t- a lot of negative consequences come as a result of using. So, the bottom line is I don’t think we should consider it normal especially because you’re drinking at an age that’s not even legal. Often people in college are 18, 19, 20 years old and that’s not even the age you’re even allowed to use alcohol. And again, other drugs are illegal in general. At no point do I think that the prevalence should be interpreted as condoning it as something’s that’s normal. Unfortunately, does it happen? Yes, it does.

Hayley: So, where would you draw that line between somebody experimenting with alcohol a little bit when they start college, like a typical behavior, to an addiction, where is that line? Because somebody could miss class because they drank the night before. Where’s that line between that, and then a real problem?

Dr. Bhatt: I think we use the same criteria that we do when we talk about defining substance use disorders in general, when we start to see a pattern. When a pattern of substance use becomes so persistent or so prevalent that it starts to predominate somebody’s life, or when it starts to cross boundaries where it starts to impair your functioning, where you start to fail out of school, where your health gets affected, where legal consequences could arise, where your relationships start to get compromised. So, the same way that we look at addiction or classify a substance use disorder in the general population would apply to somebody going beyond experimentation and crossing that line into an actual disorder.

Hayley: Yeah, I read that the National Institute on Alcohol Abuse and Alcoholism states that 9% of college students meet the criteria for an alcohol use disorder. Could this number be much higher in reality?

Dr. Bhatt: When we do a lot of studies, we often capture just the people who participate, so, those who don’t participate are excluded. So by virtue, just looking at it that way, yeah, could it possibly be higher? Of course. That’s something to really consider. But I think the point is, is how can we address this? How can we look at the percentage of the population in college, or young adults, or even let’s start earlier- adolescence and teenage years, how can we stop them from using? And I think that the public service campaigns that have been out there, just the constant education that comes out of different types of commercials that we see and stuff that’s going on, on the college campuses themselves in terms of preventing people from using in the first place, those things have actually started to take traction. So, those are positive things and those are things that I think we need to focus on.

Hayley: Yeah, that’s good to hear and that was actually kind of my next question. I’ve seen that 1500 college students die from alcohol related injuries each year. How can we make young adults take this information seriously?

Dr. Bhatt: Well, again, to take it seriously often for many people it’s the result of the negative consequences that occur when they hit rock bottom, when you develop a substance use problem, when something bad happens to them. But, the point is, the consistent and repetitive messaging and to do it in a way that’s not judgmental, and not to be punitive, but again, making it age related, age sensible and something that people can understand. Again, it is taking traction especially with certain delays that we’re seeing in the onset of what you mentioned, the ages that you mentioned when somebody first uses alcohol, it’s gone back a year. And when somebody’s using Cocaine, that’s also gone back a year. So, obviously whatever campaigns that have been done- primary preventions, public service announcements, college education, these things are working. We just have to be consistent in continuing this.

Hayley: I also want to talk about the other risky situations that substance abuse can put students in. You hear a lot about that in cases of sexual assault or assault in general, can you kind of talk on that a little bit?

Dr. Bhatt: Yeah, this is sad. College campuses having to increase policing, security, lighting, because some campuses are so huge especially when you live on campus and you’re crossing at various times of the day, and assaults can occur. And it’s unfortunate that in a civilized society like this that we have to worry about these types of things, and especially on college campuses where people are there to receive an education you would think that there’s a level of sophistication that should be occurring. When you mix drugs and alcohol, you’re impairing people’s judgment, you’re impairing people’s impulses, you’re impairing people who may be committing the act, but you’re impairing people who could defend themselves upon getting acted upon or putting themselves in precarious situations. Again, not putting any blame on them- but maybe not being as vigilant enough to maybe see a warning sign. So, people drinking unfortunately they take risky behaviors on and you see a lot of motor vehicle accidents that are happening which result not only in physical disability, but death. We do see the sexual assaults and physical assaults, people getting into bar fights, people getting raped and people then ultimately having not only mental, physical, and psychological problems, but then even if they’re not in those situations then they start failing out of school or having academic problems and ultimately maybe developing a substance use disorder for the long haul. Obviously, we want to prevent all of these things.

Hayley: The next thing I want to talk about is the demographics. Are some groups more at risk than others? Men, women, you also hear a lot about Greek life fraternities and sororities.

Dr. Bhatt: When some of these surveys are done, we do see males having slightly higher incidents in the prevalence of substance use when we talk about substance use in general. Yeah, being in a fraternity or being in a sorority- or being in any group- let’s just say that because I don’t want to call out the fraternal or sorority life in this situation. But, yeah, being around a group of people, your peers, everybody’s together doing something, it’s an increase in the likelihood that you’re going to participate in this because we are a product of our environment. Also, younger people have shown right now to not be experimenting as much, so some of these older folks- the people that are now 21, of age, and they’re in that system with that group that is using in higher incidences, these are the populations that we’re seeing are using a lot. People who might have co-occurring genetic predispositions to this, they might start to drink more robustly. Those who might’ve drank earlier than college or used drugs earlier than college, and again, I don’t want to keep using the word drinking because we’re talking about drugs in general- yeah, they’re going to continue to use as they get into college. So, there’s a lot of risk factors that are there. The presence or absence of any underlying mental health conditions, people who might have any physical ailment, all of these people are at risk for abusing or using substances, but again, the environments that you just mentioned like Greek life and all that, yeah, that can contribute.

Hayley: What would your advice be to a college student who is feeling pressured to use drugs or alcohol and they feel that they’re not going to fit in if they don’t participate?

Dr. Bhatt: I really would try and seek some counseling or help because luckily on most college campuses there are student mental health services that you can go to and speak with somebody. It’s best to get professional help and assistance, not to feel alone. I mean obviously if you’re listening to this podcast, it would sound very generic for me to say go out and get help and talk to somebody and don’t feel pressured, because there’s so many negative things that can happen. But at the same time, is there normal experimentation that’s going to occur and so how would we know if that person whose going to experiment is going to turn into somebody who’s going to end up having a disorder and being that we can’t determine this on this podcast, it’s best that my first advice would be the most accurate one, which is to go and speak to somebody that can actually evaluate you or look at your whole comprehensive life and make an assessment of it to see what risks are there, what support might be out there. Because there are actually abstinent groups on many college campuses where you don’t have to be associated with people that are using, but actually get support from people that are strong in their sobriety and solid in their sobriety and get a lot of support from them. So, there are resources out there and I would go ahead and seek them out. Usually it’s in the student services or student counseling centers.

Hayley: Okay, perfect. Thank you for sharing that, that’s great advice. Another advice question, what if someone’s friend is abusing drugs and they want to help them, but they’re worried about getting them in trouble at the school or with their parents, what can they do?

Dr. Bhatt: Luckily, first and foremost, even if you’re underage seeking help or assistance or treatment, it’s protected, it’s confidential, even as a minor with substance abuse and mental health problems in most places, and not coming across as judgmental. One of the biggest things that people do once they do develop a problem, they are often not in recognition of it and they’re defenses go up. One of the most common defenses that we see is denial. So, if you come really aggressively at somebody or in a way that sounds offensive to them, they can get very defensive, they can deny the problem and it can actually ruin your relationship. You’re looking out for your loved one or your friend and it backfires on you. So, the first thing I would say is try not to be judgmental and be honest about a concern that you have, but don’t do it when they’re intoxicated, don’t do it when they’re under the influence because you’re not going to be speaking to a person who has the ability to think rationally at that moment. So, pick a point in time where you can speak to them without being judgmental and without them being intoxicated and not coming across aside from just being supportive and concern- that you’re worrying about them and you care about them and disclaim that upfront, and that’s why you’re having that conversation. Beyond that, often guiding them if they don’t want to talk to you or don’t want to explore this, maybe have somebody else make a determination and make an assessment and again, that goes back to student services and the counseling centers that often exist on campus. And then, often not having the friend speak to the person that they’re worried about directly, but going to the counseling center and sharing that anonymously first to see if there’s interventions available on campus that might be able to have somebody go out and speak with them and guide them on a more intimate and professional route. That would be my feedback right now just speaking to the general audience on how I would approach it.

Hayley: And my last question, I think a lot of our potential listeners to this episode might be parents that are concerned about their child. How can parents talk about substance abuse in a realistic way with their kids when they’re heading off for college?

Dr. Bhatt: An honest conversation. It’s the best one. Often, without projecting a lot of previous histories a lot of times we carry a lot of baggage with us. So, if the conversation’s coming loaded because of a family history of substance abuse and all that, sometimes it can come across as accusatory versus supportive. But, being honest, being aware that this is going to be something they’re going to come across, and just trying to provide support and education that there are negative consequences to this and if you are going to experiment or if they are close to a drinking age or legal age at least to consume alcohol, not to drink and drive, to reach out to them, or just have a designated driver. Look at those practical aspects because people are going to go and drink, and especially when they come of age. So, to be safe and then to also just reach out for help and talk about the services that could be available on campus if they find themselves I a dilemma or they feel pressured to do something. Because the realistic part of it is, like I said, we don’t want to call this normal but we have to understand that there is going to be people who are going to be starting to use or be tempted to use it just due to the environment that they’re in and the age group that they’re with. So, without being judgmental, without sounding accusatory, being supportive and telling them that they know that this is something they’re going to come across and just to be safe and that they’re concerned about them, and that they’re available to them if they find themselves in a precarious situation. Usually that’s a very good approach, especially for somebody that doesn’t have a problem yet. And usually if you’ve been around your child and you’ve supported and cultivated your child, and this is not the first time you’re hopefully having a difficult conversation, so as long as you take it and be open-minded usually you’re going to get a good response from your kid. I would start like that.

Hayley: Okay, perfect. So, really just keeping that open communication, no judgment. Dr. Bhatt, is there anything that we didn’t go over that you think people should know?

Dr. Bhatt: Ultimately, the earlier someone uses is a huge risk factor. When we talk about substance use disorders in general, we’ve seen this happen especially with the opioid epidemic and the fact that so many overdoses are occurring in the nation, especially during this time with the pandemic. The unfortunate part is a lot of drug use and substance abuse is rooted with people that used early and if we can avoid or delay, we can delay the effects on mental health issues, physical issues, the development of neuro or cognitive disorders of physical accidents that could occur, and the ultimate development of addiction. Our brain is still developing from 13 to 22 in many different important areas of the brain that control our judgment, our impulses, concentration, attention, our executive functioning is if I could just be concise with that. So, the better we can control our first attempts at using any substances, the better off we’re going to be and we can avoid long-term consequences and really that would be my most appointed message that I could leave at the end of this podcast.

Hayley: For our listeners, if you want to learn more about substance abuse in college go to where you can get information and access to resources. Don’t forget to subscribe wherever you get your podcasts and thank you for listening to this episode of Straight Talk With The Doc.

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Dr. Ashish Bhatt

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  • Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.

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